A discussion paper outlining that infection control programs rely on healthcare providers underst... more A discussion paper outlining that infection control programs rely on healthcare providers understanding the modes of transmission of infectious organisms and knowing how, when and why to apply basic principles of infection control.
Background: Collaboration between education providers and clinical agencies to develop models tha... more Background: Collaboration between education providers and clinical agencies to develop models that facilitate cross-disciplinary clinical education for students is essential to produce work-ready graduates.
Similar to the U.S.A., New Zealand and Singapore, Australia registers two levels of nurse, the de... more Similar to the U.S.A., New Zealand and Singapore, Australia registers two levels of nurse, the degree or postgraduate entry prepared registered nurse and diploma or certificate-prepared enrolled nurse. Over the past decade, significant changes have occurred in educational preparation of enrolled nurses. This has resulted in enrolled nurses undertaking many roles and responsibilities previously undertaken only by registered nurses. An exploratory qualitative research study using interviews with educators of both registered and enrolled nurses was undertaken to investigate differences in educational preparation of registered and enrolled nurses in Australia. This paper describes perceptions around how participants viewed educational approaches and different cohorts, types and levels of students. Similarities included topics covered and the majority skills taught, although high acuity skills remain a difference between the levels of nurse. Differences were also found in type of student...
There are two categories of nurse registered to practise in Australia, the degree-educated regist... more There are two categories of nurse registered to practise in Australia, the degree-educated registered nurse and the certificate/diploma trained enrolled nurse (EN). While it is argued that the roles of the two categories of nurse in Australia are different, recent changes to the educational preparation and supervision requirements of ENs have narrowed these differences. This paper examines the existing literature to determine the perceived differences and similarities between registered and ENs in Australia. Differences identified included registration requirements, educational preparation, supervisory requirements and role expectation. Further research needs to be undertaken to examine the educational preparation of registered and ENs in order to obtain a greater understanding of role expectations on graduation. Supervision processes also require reviewing to demonstrate differences between indirect supervision and independent practice for ENs.
In order to identify opportunities to build capacity for clinical placements, we mapped and descr... more In order to identify opportunities to build capacity for clinical placements, we mapped and described the organisation of student placements at three hospitals, each with multiple education providers, in rural Victoria, Australia. Using a cross-sectional, mixed method design, data were collected by survey, interviews and discussion with student placement coordinators representing 16 clinical health disciplines. Teaching and supporting students was regarded as an important part of the service each hospital provided and a useful staff recruitment strategy. There were peaks and troughs in student load over the year, though this was less marked for medicine and dentistry than for nursing and allied health disciplines. Whilst placements were managed largely on a discipline basis, each hospital had taken steps to communicate information about student placements across disciplines and to identify opportunities for interprofessional education (IPE). Placement capacity could be increased by sharing placement data within hospitals, smoothing the utilisation patterns across the year, capitalising on opportunities for IPE when there is concurrent placement of students from different disciplines, and through better employment of underutilised clinical areas.
s u m m a r y Worldwide, universities have been encouraged to increase the number of students enr... more s u m m a r y Worldwide, universities have been encouraged to increase the number of students enrolled in nursing courses as a way to bolster the domestic supply of graduates and address workforce shortages. This places pressure on clinical agencies to accommodate greater numbers of students for clinical experience who, in Australia, may often come from different educational institutions. The aim of this study was to develop and evaluate a collaborative model of clinical education that would increase the capacity of a health care agency to accommodate student placements and improve workplace readiness. The project was undertaken in a medium sized regional hospital in rural Australia where most nurses worked part time.
AimTo investigate the current literature to gain an understanding of skill mix, why it is being m... more AimTo investigate the current literature to gain an understanding of skill mix, why it is being manipulated and how it affects patient care and health-care costs.To investigate the current literature to gain an understanding of skill mix, why it is being manipulated and how it affects patient care and health-care costs.BackgroundDue to workforce shortages, economic constraints and increasing patient acuity, employers are looking at methods of providing patient care whilst maintaining costs. Registered nurses make up a large percentage of the health-care budget. The manipulation of skill mix (i.e. the percentage of registered nurses available for patient care) is seen as one method of managing the increasing cost whilst still ensuring patient care.Due to workforce shortages, economic constraints and increasing patient acuity, employers are looking at methods of providing patient care whilst maintaining costs. Registered nurses make up a large percentage of the health-care budget. The manipulation of skill mix (i.e. the percentage of registered nurses available for patient care) is seen as one method of managing the increasing cost whilst still ensuring patient care.EvaluationResearch literature was used to determine the current use of skill mix and its impact on patient care and health-care costs.Research literature was used to determine the current use of skill mix and its impact on patient care and health-care costs.Key issueThe use of a higher proportion of registered nurses is associated with better health outcomes, shorter length of stay and reduced patient morbidity.The use of a higher proportion of registered nurses is associated with better health outcomes, shorter length of stay and reduced patient morbidity.ConclusionEconomic savings from substituting registered nurses with other health professionals may be offset by increased patient length of stay in hospital and increased patient mortality.Economic savings from substituting registered nurses with other health professionals may be offset by increased patient length of stay in hospital and increased patient mortality.Implications for nursing managementWhen evaluating nursing skill mix, a higher percentage of registered nurses may result in health-care facility cost savings by providing a shorter length of stay and decreased patient complications.When evaluating nursing skill mix, a higher percentage of registered nurses may result in health-care facility cost savings by providing a shorter length of stay and decreased patient complications.
Significant changes to the scope of practice for enrolled nurses have occurred in Australia over ... more Significant changes to the scope of practice for enrolled nurses have occurred in Australia over the past decade. These changes, which are largely a consequence of staff shortages and economic pressure, have resulted in increased role confusion and overlap between enrolled and registered nurses in Australia. This paper presents a brief history of the enrolled nurse in Australia followed by an overview of the current situation and emerging trends in the education and employment of these nurses. Definitions and approaches to scope of practice are described and emerging issues within Australia raised and discussed. A review of the literature found the number of enrolled nurses and the roles they perform have changed significantly in Australia following the introduction of the enhanced scope of practice. Further research is required to better define and delineate between the different nursing roles and to explore broader frameworks to analyze, describe and define these roles.
The current workforce crisis mandates that education providers increase the number of graduates f... more The current workforce crisis mandates that education providers increase the number of graduates from nursing courses. In a practice-based profession however, any growth in student numbers is constrained by the ability of clinical venues to accept students for clinical experience. Factors within the operating environment such as bed capacity, staffing mix and shortage of experienced clinicians to act as preceptors, clinical teachers, mentors or role models; limit the number of students that can be accommodated and both the quality and level of educational support provided. These factors are compounded in rural hospitals, where opportunities for placements can be also overlooked or ineffectively utilised. This paper reports on a project undertaken by a rural health service, two universities and a TAFE institute. It demonstrates that a greater number of students can be accommodated when all major stakeholders accept responsibility and agree to work together to create a learning community and find ways to overcome barriers and impediments that constrain capacity. It is concluded that the capacity of a rural hospital to accept students for placement can be increased when cancellation rates are reduced, the clinical timetable rationalised and more collaborative approaches to clinical education are implemented.
The current shortage of health professionals necessitates new approaches to clinical education th... more The current shortage of health professionals necessitates new approaches to clinical education that can expand the number of undergraduate students undertaking clinical placements without increasing the burden on clinical staff or placing patients at risk. Interprofessional education has the potential to help increase clinical capacity whilst enriching students' clinical experience. This paper reports on a project which investigated the potential for interprofessional education to increase undergraduate clinical placement capacity in clinical settings. The project utilised an exploratory descriptive methodology to obtain the views of health care professionals about the use of interprofessional education in clinical education at three rural health facilities in Victoria, Australia. Participants (n = 57) had a key role with each health care facility in coordinating and facilitating undergraduate clinical placements. This paper examines the clinicians' views about the central role that leadership plays in actioning interprofessional education in the clinical setting. Whilst interprofessional education was regarded favourably by the majority of participants, data indicated that leadership from education providers, health services, and regulatory authorities was crucial to enable interprofessional education to be implemented and sustained within the clinical learning environment. Without leadership from each of these three spheres of influence, interprofessional education will continue to be difficult to implement for undergraduate students and compromise their exposure to an important aspect of the working life of health care professionals. Such a failure will limit graduates' readiness for collaborative and cross-disciplinary practice.
Rural registered nurses' experiences of advanced clinical nursing practice were explored whilst t... more Rural registered nurses' experiences of advanced clinical nursing practice were explored whilst they were enrolled in an advanced primary care course of study. Thirty-two nurses employed in rural health services in Victoria, Australia, studied advanced practice nursing by distance education with a clinical component. At course conclusion, focus groups and a quantitative on-line survey were conducted to explore outcomes. Nurses reported positive selfperceptions of their educational preparation with scores of >7/10 for competence, confidence, preparedness for advanced practice and job satisfaction. Focus group discussions concurred with positive survey results. The course was valuable in developing skills and knowledge, enabling more holistic patient care. The main themes that emerged related to the advancement of the nurse as a professional, and enhancement of patient care. Within their scope of practice, nurses assessed, diagnosed and treated minor patient illness presentations either independently or collaboratively with medical advice. The context of rural health services dictated practice and levels of autonomy. Nurses perceived the new role reduced an overload of medical work, whilst increasing patients' access to care. As a result of the course 24% of participants reported a change in their work role. Nurses employed in rural health services reported positive potential for advanced collaborative practice in rural health care, in association with medical professionals. Defined role boundaries, role responsibilities and dedicated advanced practice positions will be required to achieve implementation of the role.
Objective: The increase in level of academic qualifications for enrolled nurses in Australia has ... more Objective: The increase in level of academic qualifications for enrolled nurses in Australia has resulted in them graduating with an increased knowledge and skill base to previous enrolled nursing graduates. This has resulted in a higher level of practice role overlap between degree prepared registered nurses and diploma prepared enrolled nurses in Australia. This paper reports on a study undertaken to ascertain the role expectations of registered and enrolled nursing students in the final year of their education prior to registration. Main points: Students were also asked to indicate how well prepared they felt for the roles they expected to perform. The study used a self-reporting survey to explore the role expectations of graduate nurses from the different nursing educational institutions in Victoria, Australia. Comparison of role expectations will be explained across a range of variables including patient care, administration, teamwork, supervision/leadership, education and rese...
A discussion paper outlining that infection control programs rely on healthcare providers underst... more A discussion paper outlining that infection control programs rely on healthcare providers understanding the modes of transmission of infectious organisms and knowing how, when and why to apply basic principles of infection control.
Background: Collaboration between education providers and clinical agencies to develop models tha... more Background: Collaboration between education providers and clinical agencies to develop models that facilitate cross-disciplinary clinical education for students is essential to produce work-ready graduates.
Similar to the U.S.A., New Zealand and Singapore, Australia registers two levels of nurse, the de... more Similar to the U.S.A., New Zealand and Singapore, Australia registers two levels of nurse, the degree or postgraduate entry prepared registered nurse and diploma or certificate-prepared enrolled nurse. Over the past decade, significant changes have occurred in educational preparation of enrolled nurses. This has resulted in enrolled nurses undertaking many roles and responsibilities previously undertaken only by registered nurses. An exploratory qualitative research study using interviews with educators of both registered and enrolled nurses was undertaken to investigate differences in educational preparation of registered and enrolled nurses in Australia. This paper describes perceptions around how participants viewed educational approaches and different cohorts, types and levels of students. Similarities included topics covered and the majority skills taught, although high acuity skills remain a difference between the levels of nurse. Differences were also found in type of student...
There are two categories of nurse registered to practise in Australia, the degree-educated regist... more There are two categories of nurse registered to practise in Australia, the degree-educated registered nurse and the certificate/diploma trained enrolled nurse (EN). While it is argued that the roles of the two categories of nurse in Australia are different, recent changes to the educational preparation and supervision requirements of ENs have narrowed these differences. This paper examines the existing literature to determine the perceived differences and similarities between registered and ENs in Australia. Differences identified included registration requirements, educational preparation, supervisory requirements and role expectation. Further research needs to be undertaken to examine the educational preparation of registered and ENs in order to obtain a greater understanding of role expectations on graduation. Supervision processes also require reviewing to demonstrate differences between indirect supervision and independent practice for ENs.
In order to identify opportunities to build capacity for clinical placements, we mapped and descr... more In order to identify opportunities to build capacity for clinical placements, we mapped and described the organisation of student placements at three hospitals, each with multiple education providers, in rural Victoria, Australia. Using a cross-sectional, mixed method design, data were collected by survey, interviews and discussion with student placement coordinators representing 16 clinical health disciplines. Teaching and supporting students was regarded as an important part of the service each hospital provided and a useful staff recruitment strategy. There were peaks and troughs in student load over the year, though this was less marked for medicine and dentistry than for nursing and allied health disciplines. Whilst placements were managed largely on a discipline basis, each hospital had taken steps to communicate information about student placements across disciplines and to identify opportunities for interprofessional education (IPE). Placement capacity could be increased by sharing placement data within hospitals, smoothing the utilisation patterns across the year, capitalising on opportunities for IPE when there is concurrent placement of students from different disciplines, and through better employment of underutilised clinical areas.
s u m m a r y Worldwide, universities have been encouraged to increase the number of students enr... more s u m m a r y Worldwide, universities have been encouraged to increase the number of students enrolled in nursing courses as a way to bolster the domestic supply of graduates and address workforce shortages. This places pressure on clinical agencies to accommodate greater numbers of students for clinical experience who, in Australia, may often come from different educational institutions. The aim of this study was to develop and evaluate a collaborative model of clinical education that would increase the capacity of a health care agency to accommodate student placements and improve workplace readiness. The project was undertaken in a medium sized regional hospital in rural Australia where most nurses worked part time.
AimTo investigate the current literature to gain an understanding of skill mix, why it is being m... more AimTo investigate the current literature to gain an understanding of skill mix, why it is being manipulated and how it affects patient care and health-care costs.To investigate the current literature to gain an understanding of skill mix, why it is being manipulated and how it affects patient care and health-care costs.BackgroundDue to workforce shortages, economic constraints and increasing patient acuity, employers are looking at methods of providing patient care whilst maintaining costs. Registered nurses make up a large percentage of the health-care budget. The manipulation of skill mix (i.e. the percentage of registered nurses available for patient care) is seen as one method of managing the increasing cost whilst still ensuring patient care.Due to workforce shortages, economic constraints and increasing patient acuity, employers are looking at methods of providing patient care whilst maintaining costs. Registered nurses make up a large percentage of the health-care budget. The manipulation of skill mix (i.e. the percentage of registered nurses available for patient care) is seen as one method of managing the increasing cost whilst still ensuring patient care.EvaluationResearch literature was used to determine the current use of skill mix and its impact on patient care and health-care costs.Research literature was used to determine the current use of skill mix and its impact on patient care and health-care costs.Key issueThe use of a higher proportion of registered nurses is associated with better health outcomes, shorter length of stay and reduced patient morbidity.The use of a higher proportion of registered nurses is associated with better health outcomes, shorter length of stay and reduced patient morbidity.ConclusionEconomic savings from substituting registered nurses with other health professionals may be offset by increased patient length of stay in hospital and increased patient mortality.Economic savings from substituting registered nurses with other health professionals may be offset by increased patient length of stay in hospital and increased patient mortality.Implications for nursing managementWhen evaluating nursing skill mix, a higher percentage of registered nurses may result in health-care facility cost savings by providing a shorter length of stay and decreased patient complications.When evaluating nursing skill mix, a higher percentage of registered nurses may result in health-care facility cost savings by providing a shorter length of stay and decreased patient complications.
Significant changes to the scope of practice for enrolled nurses have occurred in Australia over ... more Significant changes to the scope of practice for enrolled nurses have occurred in Australia over the past decade. These changes, which are largely a consequence of staff shortages and economic pressure, have resulted in increased role confusion and overlap between enrolled and registered nurses in Australia. This paper presents a brief history of the enrolled nurse in Australia followed by an overview of the current situation and emerging trends in the education and employment of these nurses. Definitions and approaches to scope of practice are described and emerging issues within Australia raised and discussed. A review of the literature found the number of enrolled nurses and the roles they perform have changed significantly in Australia following the introduction of the enhanced scope of practice. Further research is required to better define and delineate between the different nursing roles and to explore broader frameworks to analyze, describe and define these roles.
The current workforce crisis mandates that education providers increase the number of graduates f... more The current workforce crisis mandates that education providers increase the number of graduates from nursing courses. In a practice-based profession however, any growth in student numbers is constrained by the ability of clinical venues to accept students for clinical experience. Factors within the operating environment such as bed capacity, staffing mix and shortage of experienced clinicians to act as preceptors, clinical teachers, mentors or role models; limit the number of students that can be accommodated and both the quality and level of educational support provided. These factors are compounded in rural hospitals, where opportunities for placements can be also overlooked or ineffectively utilised. This paper reports on a project undertaken by a rural health service, two universities and a TAFE institute. It demonstrates that a greater number of students can be accommodated when all major stakeholders accept responsibility and agree to work together to create a learning community and find ways to overcome barriers and impediments that constrain capacity. It is concluded that the capacity of a rural hospital to accept students for placement can be increased when cancellation rates are reduced, the clinical timetable rationalised and more collaborative approaches to clinical education are implemented.
The current shortage of health professionals necessitates new approaches to clinical education th... more The current shortage of health professionals necessitates new approaches to clinical education that can expand the number of undergraduate students undertaking clinical placements without increasing the burden on clinical staff or placing patients at risk. Interprofessional education has the potential to help increase clinical capacity whilst enriching students' clinical experience. This paper reports on a project which investigated the potential for interprofessional education to increase undergraduate clinical placement capacity in clinical settings. The project utilised an exploratory descriptive methodology to obtain the views of health care professionals about the use of interprofessional education in clinical education at three rural health facilities in Victoria, Australia. Participants (n = 57) had a key role with each health care facility in coordinating and facilitating undergraduate clinical placements. This paper examines the clinicians' views about the central role that leadership plays in actioning interprofessional education in the clinical setting. Whilst interprofessional education was regarded favourably by the majority of participants, data indicated that leadership from education providers, health services, and regulatory authorities was crucial to enable interprofessional education to be implemented and sustained within the clinical learning environment. Without leadership from each of these three spheres of influence, interprofessional education will continue to be difficult to implement for undergraduate students and compromise their exposure to an important aspect of the working life of health care professionals. Such a failure will limit graduates' readiness for collaborative and cross-disciplinary practice.
Rural registered nurses' experiences of advanced clinical nursing practice were explored whilst t... more Rural registered nurses' experiences of advanced clinical nursing practice were explored whilst they were enrolled in an advanced primary care course of study. Thirty-two nurses employed in rural health services in Victoria, Australia, studied advanced practice nursing by distance education with a clinical component. At course conclusion, focus groups and a quantitative on-line survey were conducted to explore outcomes. Nurses reported positive selfperceptions of their educational preparation with scores of >7/10 for competence, confidence, preparedness for advanced practice and job satisfaction. Focus group discussions concurred with positive survey results. The course was valuable in developing skills and knowledge, enabling more holistic patient care. The main themes that emerged related to the advancement of the nurse as a professional, and enhancement of patient care. Within their scope of practice, nurses assessed, diagnosed and treated minor patient illness presentations either independently or collaboratively with medical advice. The context of rural health services dictated practice and levels of autonomy. Nurses perceived the new role reduced an overload of medical work, whilst increasing patients' access to care. As a result of the course 24% of participants reported a change in their work role. Nurses employed in rural health services reported positive potential for advanced collaborative practice in rural health care, in association with medical professionals. Defined role boundaries, role responsibilities and dedicated advanced practice positions will be required to achieve implementation of the role.
Objective: The increase in level of academic qualifications for enrolled nurses in Australia has ... more Objective: The increase in level of academic qualifications for enrolled nurses in Australia has resulted in them graduating with an increased knowledge and skill base to previous enrolled nursing graduates. This has resulted in a higher level of practice role overlap between degree prepared registered nurses and diploma prepared enrolled nurses in Australia. This paper reports on a study undertaken to ascertain the role expectations of registered and enrolled nursing students in the final year of their education prior to registration. Main points: Students were also asked to indicate how well prepared they felt for the roles they expected to perform. The study used a self-reporting survey to explore the role expectations of graduate nurses from the different nursing educational institutions in Victoria, Australia. Comparison of role expectations will be explained across a range of variables including patient care, administration, teamwork, supervision/leadership, education and rese...
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Papers by Elisabeth Jacob